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Comment by anilgulecha | Hacker News Reader

I'm part of the Jain community in Bangalore, and the version of this in society exists, called Sallekhna [1], a tradition that's developed over millennia, and this is venerated and celebrated.

The philosophical underpinning is giving up of materialness. The practicality of the 5 instances that I witnessed over the past year - typical terminal individuals choose this. They pass away surrounded by loved ones (they typically medicate for any pain, and the body starts shutting down when food and water stops). This is observed with somberness, but celebrated as very positive act.

When someone starts this process, it's a unique experience speaking with them, as there's usually nothing that comes up, and the moment does not really lend itself to small talk :)

[1] https://en.wikipedia.org/wiki/Sallekhana

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Thank you for sharing this. My grandpa passed away earlier this year at the young age of 97. We discovered a kidney cancer and decided not to treat him and bring him back home.

During his final days, he became unresponsive, only sleeping. The doctors gave us the option of feeding him through a tube. We made the hard decision of not doing it. Gave him all the medicine to help his body heal, but no invasive procedures.

We stayed by his side for the next 5 days. Playing songs that he enjoyed. Audiobooks that he loved. And just taking care of him.

Finally, his breath became slower and slower until it stopped and he passed away. I had the opportunity of being beside him during his last breath.

The passing of loved ones is always difficult, but I am grateful for how he went. He lived a full life and was incredibly healthy until the end.

Without knowing, we decided on a sallekhana-like process for him. It was the right thing to do.

Thank you for showing me this.

This is essentially what hospice is in the US. They stop curative treatment and focus on comfort. Then at the end when the person can no longer function to eat or drink they increase the morphine dose to a high level until they pass.

Right. It's a not-so-well-kept secret that hospice care is actually assisted suicide in disguise. It's done with a wink and a nudge, hiding behind the principle of double effect, but it's a mercy everyone knows is happening. It's sad that it has to be done covertly.

Which is highly illegal, especially as a form of monetizing pain and lack of agency from elders incapable of decision making but flush with money and inheritors

And replies like this is why it’s clandestine.

This is a misconception—research has found that people entering hospice often live longer than those who do not:

https://www.sciencedirect.com/science/article/pii/S088539240...

There are many who will raise their hands with anecdotal counters to this, but I think much of that is borne from misunderstandings about end of life generally, which is a charged and difficult topic lots of people would rather not learn more about.

I highly recommend the book Being Mortal by Atul Gawande for anyone who wants to explore the topic further—or really for anyone who has loved ones at all!

Very interesting. This definitely contradicts my direct experience. I'll have to give the study a close read. Thank you for sharing it.

Of course, bring the patient home to die is no different. And nobody would call that assisted suicide.

Ever since I learned of Jainism I’ve wished I’d learned of it earlier.

Thank you I just learned about it. Seems compatible with atheism.

It absolutely does not. Jainism is even stricter than Hinduism, to be co-opted with a faithless belief system

It's atheistic in that it's godless (more focused on saints). In its orthodoxy it requires a lot from any practitioner, towards its philosophy.

Atheism isn’t a faithless belief system, it is the absence of either a faith or a belief system.

That absence is also quite compatible with Jainism, the core moral precept of which is simply do no violence.

In a similar vein India also has/had Thalaikoothal, which is more of a traditional method of homicide than suicide.

[0] https://en.wikipedia.org/wiki/Thalaikoothal

"They are given an oil bath and made to drink glasses of coconut water"

I'm surprised that someone can be killed in this way. Is it the electrolyte imbalance? There's a lot of potassium in coconut water.

Yup—too much potassium.

Apparently you can (almost) do it unintentionally if you play tennis in the heat—though 88oz (2.6L) seems like a lot!

Here’s a case report:

Hakimian, J., Goldbarg, S. H., Park, C. H., & Kerwin, T. C. (2014). Death by Coconut. Circulation: Arrhythmia and Electrophysiology, 7(1), 180–181. https://doi.org/10.1161/circep.113.000941

How did they medicate for pain for millennia before the advent of painkillers?

Are we pretending opioids do not exist in nature? What's next, how did people hallucinate before LSD?

Before the early modern period, large portions of the world did not have any wild or cultivated opium poppies or any other strong painkillers.

Jainism developed in India which did have access to these. Regardless, until the early modern period painkillers and other medical treatment was blanket disapproved of as it was considered likely to be damaging some part of the body. (My non-expert understanding).

People were probably suffering a lot. I can't imagine being a migraine sufferer in 1500. It's miserable enough now.

How long does this actually take?

Hard fast (e.g. hunger strikes) usually take about 2 months to kill a healthy adult.

On the one hand according to the wiki this is more progressive removing food by degrees which would make the process a lot longer.

On the other hand being a mostly ascetic practice I'd assume it's done by people who have a lot less reserves (body fat and muscle) which would shorten the process significantly (the 207kg Angus Barbieri famously fasted continuously for 382 days[0] breaking his fast at 82kg, although he supplemented his liquids — water, tea, and coffee — with vitamins, electrolytes, and yeast extract, the latter for essential amino acids).

[0]: technically he was put on a recovery diet of salting then sugaring his water for 10 days, so ate no solid food for 392 days, breaking his fast with a boiled egg and a slice of buttered bread

Liquids are also removed (gradually). For someone already in weakened condition, I would be surprised if the process took longer than two weeks.

Ah I'd missed that part, in that case yes it would go much faster, dehydration is a quick way out (though not a comfortable one).

The earliest was under a day. The latest was about 2 weeks. I've heard of about 45 days one as well.. but thats unusual.

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